Dr. Rudy Jerome Vervaeke
Internist - Addiction Medicine
21420 Harper Ave Suite 2
Saint Clair Shores
, Michigan 48080-3607
Dr. Rudy Jerome Vervaeke
Internist - Addiction Medicine
21420 Harper Ave Suite 2
Saint Clair Shores
, Michigan 48080-3607
(586) 775-0091
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About
Features
Specialties
- Internist - Addiction Medicine
Languages spoken
- English
Location
First Address
- Dr. Rudy Jerome Vervaeke
- 21420 Harper Ave Suite 2
- Saint Clair Shores, MI
- Zip : 48080-3607
- Fax : (586) 775-0091
- Phone : (586) 775-7400
Second Address
- Dr. Rudy Jerome Vervaeke
- 21420 Harper Ave Suite 2
- Saint Clair Shores, MI
- Zip : 48080-3607
- Fax : (586) 775-0091
- Phone : (586) 775-7400
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RA0401X | Internist - Addiction Medicine | 4301044898 | MI |
National Provider Identifier
| NPI | 1922108927 |
|---|---|
| Provider Name | Dr. Rudy Jerome Vervaeke |
| First Address | Saint Clair Shores, MI 48080-3607 |
| Second Address | Saint Clair Shores, MI 48080-3607 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/09/2006 |
| Last Update Date | 20/11/2015 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1105018171 | BLUE CROSS BLUE SHIELD (01) | MA |
| 352263519 | COMMERCIAL (01) | MI |
| 4842512-10 | (05) | MI |
| B47051 | (02) | MI |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.